Loris Medical Center, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LORIS MEDICAL CENTER, PA

Practice address

3439 Casey St
Loris, SC 29569-2903

Phone

(843) 756-1582

Fax

(843) 756-2042

NPI assigned

Jun 25, 2006

Last updated

Sep 10, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Wanda Graham

Title

Practice Administrator

Phone

(843) 756-5300

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252540800000",
    "number": "1740216191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3439 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692903",
            "telephone_number": "843-756-5300",
            "fax_number": "843-756-6059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3439 CASEY ST",
            "city": "LORIS",
            "state": "SC",
            "postal_code": "295692903",
            "telephone_number": "843-756-1582",
            "fax_number": "843-756-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORIS MEDICAL CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2009-09-10",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "WANDA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "843-756-5300",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BCBS",
            "identifier": "0291J",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA6664",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950200",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1053",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO MEDICARE",
            "identifier": "4771",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loris Drug Company LLC (Loris Drug Store)
• Loris Drug Store, Inc.
• Loris Drug Store, Inc.
• Loris Eye Associates PC
• Loris Family Dentistry, LLC
• Loris Physician Services
• Loris Rehab and Nursing Center, LLC
• Loris Surgical Associates, PA
• Low Country Medical Supply
• Rita Bellamy Lowery

• Family Medicine Physician in Loris, SC
• Providers in Loris, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.